DMS 100 1
Attendance and Absences
Late arrivals of fifteen minutes or more count as missing an entire lecture.
Allow two excused absences per class per semester, but only if excused and talked about with the instructor prior to the absence.
When there are extenuating circumstances (e.g., car accident, parking garage issues), the instructor notes that there can be leniency this week, but students still need to be prepared and not rely on reteaching material.
If you are sick, do not come to class; obtain a doctor's note if illness is the cause; the instructor acknowledges the COVID context and ongoing concerns.
If you are late, inform the instructor as soon as you know (email or text). The instructor emphasizes empathy (e.g., thinking of their own kids on the road) and understanding of real-life problems.
In summary: communicate promptly, be prepared, and recognize we are human too.
Classroom Etiquette, Privacy, and Recording
Laptop use is allowed because laptops are common tools, but it must remain a learning environment; respect others.
Put phones on silent and limit non-class activities; excessive use of phones/internet can lead to being counted absent.
If you want to record lectures, inform the instructors beforehand; no problem with recording—AI-generated notes are welcomed if accurate.
Privacy in the lab: do not record people during lab sessions; HIPAA violations include sharing patient information or case details outside the lab.
Be mindful of patient privacy; case studies may feature real patients, so wording and sharing must be careful.
Encouragement to use AI and other resources for notes, but verify accuracy to avoid misinformation.
In the lab, respect patient privacy and avoid sharing identifiable information.
Syllabus, Schedule, and Lab Structure
The instructor will not reteach every detail; students should study the syllabus and follow the schedule.
Rachel will cover the day-in-the-life of a sonographer, which will be incorporated into the learning path.
Lab sessions: Rachel is the lab instructor; all lab assignments then move to her oversight.
Office hours: there are no fixed office hours; contact instructors via email to set up a time (including Zoom) as needed.
Materials: the full PowerPoint contains material; some items may be on slides and some not; students should review both and email questions.
Emphasis on steady study rather than cramming; the class is designed to build upon itself with layered learning.
The Big Picture: Professionalism and Real-World Relevance
Ultrasound and sonography are critical in diagnosing patients; imaging often happens before others and can guide orders and care.
The instructors emphasize pride in the field, the small size of the professional community in the region, and the responsibility to act ethically and compassionately.
Self-care is highlighted (including options like acupuncture/massage) to sustain long study and clinical work.
Students are encouraged to stay curious, actively participate, and seek help early if they struggle with study methods or content.
Relational and Anatomical Terminology: Core Concepts
Relational anatomy focuses on how structures relate to each other in space (e.g., liver, aorta, kidney, pancreas, spleen).
Key directional and positional terms introduced:
Anterior (ventral) vs Posterior (dorsal)
Superior (cephalic) vs Inferior (caudal)
Proximal vs Distal (only for extremities; near trunk vs far from trunk)
Medial vs Lateral (midline reference; can be applied to limbs and neck)
Supine (on the back) vs Prone (on the stomach)
Left Lateral Decubitus (lying on left side) and other oblique/position variations
Anatomic position: arms at the sides with palms up; baseline orientation
Practical notes:
Always describe findings with spatial context (e.g., a cyst is located relative to liver and kidney; specify superior/inferior, medial/lateral, etc.)
The neck anatomy example includes common carotid, thyroid, mandible, and how the carotid feeds the brain; stroke and hemorrhage risks are discussed in relation to plaques and aneurysms.
The Circle of Willis is described as very small (like the size of a quarter) where tiny plaques can have big effects.
Ultrasound Scan Planes and Image Orientation
Core scan planes used in general/vascular imaging:
Coronal (Frontal): divides body into anterior and posterior portions
Transverse (Axial, Horizontal): divides body into superior and inferior portions
Sagittal (Longitudinal, Median): divides body into left and right portions; midsagittal vs perisagittal variations exist
Orientation rules when using the transducer:
In longitudinal (sagittal), the notch should point toward the patient’s head (superior direction)
In transverse, the notch faces the patient’s right; image appears reversed left-right on screen relative to the patient
The screen’s left/right is not the patient’s left/right in transverse views; pay attention to the notch orientation to determine the correct anatomical side
Transducer notch concepts:
The notch is a physical marker on the transducer; you should indicate its orientation in the image so clinicians know the plane and side in the patient
If a plane is rotated, you must adjust the notch accordingly and describe the plane (longitudinal vs transverse) and the side (patient’s right vs left)
Practical imaging notes:
In abdominal and vascular sonography, the main planes are coronal, transverse, and sagittal; echocardiography uses clock-face terminology (e.g., 11:00, 12:00, 01:00, 02:00 positions) for probe orientation and views
The dot/notch is a critical cue for orientation; learners should identify it on their images
Standards of practice aim for consistent protocols across different regions; the notch and planes should match national or institutional protocols
Equipment and probes:
Sector, linear, and transvaginal probes were introduced; different probes produce different planes and resolutions
Image orientation examples and tips:
When viewing a long neck vessel (carotid), a surrounding muscle region is seen; blood flow appears anechoic (black) on B-mode imaging; color Doppler will later show flow
In the neck, the thyroid is anterior to the trachea and the carotid lies laterally; the trachea creates a shadow on the image
In coronal views, right/left orientation flips on screen depending on the plane and patient position; always reference the patient’s actual right/left side, not the screen’s left/right
Specific Anatomical Regions and Imaging Cues
Neck and carotids:
Common carotid and thyroid anatomy visible; the thyroid has left and right lobes with an isthmus in the middle; the carotid lies lateral to these structures
Trachea sits midline with a characteristic shadow; depth and surrounding muscles affect visibility
Abdominal vasculature: aorta and IVC
Abdominal aorta is the major trunk; posterior to the liver and near the spine
Celiac axis (celiac trunk) gives rise to gastric (left gastric), splenic, and hepatic arteries
Superior Mesenteric Artery (SMA) arises near the aorta inferior to the celiac axis and supplies the intestines
Renal arteries branch from the aorta to the kidneys; renal veins return deoxygenated blood to the IVC
Iliac arteries diverge into common iliacs, which split into external and internal iliac branches; these feed the legs and pelvic organs
The liver's left lobe sits anterior to the aorta; the SMA and celiac axis sit anterior to the aorta
The IVC runs anterior to the spine and tends to appear next to the aorta on imaging
Liver and kidney anatomy on ultrasound:
Liver described visually like ground beef in texture; the liver sits above the stomach and the aorta sits posterior to the left liver area
Kidney cross-section: cortex vs medulla; medulla is generally hypoechoic relative to the cortex; the central echogenic area (sinus fat) stands out; the renal pelvis/pyramids appear within the medulla/cortex interface
In a longitudinal kidney view, the superior portion sits toward the head; the inferior portion toward the feet
In a transverse kidney view, the medulla appears darker and the cortex lighter; the central echogenic part is the sinus fat
Heart and cardiac imaging basics (brief):
Cardiac imaging is different from abdominal/vascular imaging and is introduced with a plan to cover in more detail later
Echo windows include apical, parasternal, and subcostal approaches; apical view focuses on the apex of the heart; parasternal view is next to the sternum; subcostal view looks from under the ribs toward the heart
Clock-face orientation (e.g., 3:00, 11:00) is used to describe the viewpoint in echocardiography; breathing is often used to optimize views by moving lungs out of the way
The heart view orientation in images can appear inverted relative to everyday anatomy; practical teaching emphasizes understanding relative positions rather than assuming standard orientation
Depth and acoustic windows:
Acoustic windows vary by patient anatomy; real depth to organs can be deep (e.g., the liver and kidneys may be ~16 cm from the skin surface in some images)
Pushing with the wrist and maintaining ergonomic technique is important to obtain good images without fatigue or injury
Practical Notes for Imaging and Data Handling
Orientation and labeling practice:
Always label and describe orientation: e.g., notch toward head for longitudinal; notch toward patient’s right for transverse; specify anterior/posterior, superior/inferior, left/right as seen on the image
When describing a structure, use proximal/distal, medial/lateral, and relative to adjacent organs (e.g., aorta posterior to the liver, celiac axis anterior to the aorta)
Real-world workflow:
Be prepared to assess a patient’s anatomy and variability (e.g., horseshoe kidney, rotated organs, or situs anomalies) and adapt the plane/labeling accordingly
There is an emphasis on using images and context clues on the screen to infer anatomy correctly; mislabeling can have serious consequences (e.g., wrong organ removal or misdiagnosis)
Privacy and ethical practice:
HIPAA compliance is crucial; do not disclose patient information outside the clinical or educational environment
Treat all patients with respect; practice the “golden rule” and maintain professional behavior even in challenging situations
Study strategy and exam approach:
The course is designed to be incremental: early weeks are ~15% of the grade, with more weight on later weeks as skills build
Do not cram; study consistently (at least ~1 hour per day); use moving visuals and simulations to reinforce learning
If you’re stuck, seek guidance from instructors; email to request help, schedule Zoom or in-person sessions, and use available labs (sim lab, etc.)
Self-care and support:
The program acknowledges stress and burnout; instructors encourage self-care and support resources (e.g., acupuncture, massage) for maintaining wellbeing
Final reminders for exam readiness:
Focus on directional terminology, anatomic patient positioning, scan planes, and transducer/image orientation
Expect relational anatomy questions and the ability to translate anatomy into two-dimensional ultrasound images
Understand the core planes (coronal/frontal, transverse/axial, sagittal/longitudinal) and how the notch orientation determines which side you are viewing
Be comfortable describing the location of structures using real-world references (liver position, aorta, SMA, celiac axis, renal arteries/veins, iliac branches, etc.)
Quick Reference Concepts (condensed)
Planes: Coronal (frontal), Transverse (axial), Sagittal (longitudinal)
Notch orientation: Longitudinal notch toward head; Transverse notch toward patient’s right
Key terms: anterior, posterior, superior, inferior, proximal, distal, medial, lateral, ipsilateral, contralateral
Projections in echocardiography: apical, parasternal, subcostal; clock positions (e.g., 03:00, 11:00)
Major abdominal vessels: aorta, IVC, celiac axis (gastric/left gastric, splenic, hepatic), SMA, renal arteries/veins, iliacs
Organ relationships: left lobe of liver anterior to aorta; celiac axis/SMA anterior to aorta; portal vein and hepatic/portal system relationships in the abdomen
Lab/evidence and ethics: HIPAA, privacy, patient confidentiality; non-disclosure of case details outside teaching; consent for recording lectures
Study discipline: consistent daily study, layering of content, not cramming; use of lab instructors and sim labs for practice
Professional mindset: pride in field, patient-centered care, and the “golden rule” in practice